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On maintaining normalcy

I recently saw a man in follow up. He had lost vision in his left eye progressively over the course of a few months, associated with pain, and he was told it was cataracts. On follow up with his cataract surgeon, it was noted that his vision could not be improved more than counting fingers. He was referred and assessed urgently for giant cell arteritis/temporal arteritis. He had a known history of prostate cancer with metastases to the spine. When I assessed him, he had more than just vision loss. He was proptotic and had restricted motility. Urgent imaging was ordered for him. It was found that he had multiple mets to the bony area around the orbital apex, a region where important nerves for vision and eye movement emerged.

But when I saw him again, his primary concern wasn’t the cancer that was causing these problems, or that he was on palliative radiation and chemotherapy, it was on how the cataract surgery looked. When I told him that his lens was nicely in place, he said, “Good, can you write that in a note to my optometrist? I’m going to see her next week and I’d like her to know.”

At first I thought, he just doesn’t get it. Then I realized, no, it was me – I didn’t get it. I didn’t get that he was maintaining a normalcy in his life – of caring about the seemingly-irrelevant details and of going to appointments that aren’t centred on his cancer. If I were in his shoes, I probably would let my illness and my prognosis define me. But instead, this man went on as best as he can with “normal life” – knowing that one day it would end – but why let it end now by obsessing over the inevitable?